NURS-1094EL Lecture Notes - Lecture 6: Pulmonary Valve, Pulmonary Insufficiency, Tricuspid Valve

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Cardiovascular System Assessment
Health History
1. Any chest pain or tightness?
2. Any shortness of breath?
3. Use more than 1 pillow to sleep?
4. Do you have a cough?
5. Do you seem to tire easily?
6. Facial skin ever turn blue or ashen?
7. Awaken at night to urinate?
8. Any leg pain or (cramps)? Where?
9. Any skin changes in arms or legs?
10. Any sores or lesions in arms & legs?
11. Any swelling in the legs?
12. Any swollen glands? Where?
Physical Examination
1. Inspect & Palpate Carotid Arteries
1. Grade: Right & Left
0 = absent, 1+ weak, 2+ normal, 3+ increased, 4+ bounding
Listen for presence of bruits (blowing, swishing sound indicating blood flow turbulence)
o Normally none is present
Apply bell of stethoscope over carotid artery at 3 levels;
o Angle of jaw, mid-cervical area, base of neck
Ask the patient to take a breath, exhale, & hold without breathing while you listen so that tracheal breath
sounds do not mask or mimic a carotid artery bruit
Palpate each carotid artery medial to the sternomastoid muscle in the neck (symmetrical)
o Avoid excessive pressure on the carotid sinus area higher in the neck
o Feel contour (smooth with a rapid upstroke & slower downstroke) & amplitude (strength is 2+/moderate)
2. Inspect & Palpate Precordium
1. Skin Colour & Condition
2. Chest Wall Pulsations
Using palmar aspects of your 4 fingers, gently palpate over the apex, the left sternal border, & the base,
searching for any other pulsations (none should be present)
Thrill = palpable vibration (signifies turbulent blood flow & accompanies loud murmurs)
3. Heave or Lift
Sustained forceful thrusting of the ventricle during systole (eg. Increased workload)
4. Apical Impulse (Point of Maximal Impulse) in the 4th/5th interspace at the mid-clavicular line
Size: 1x2 cm & Amplitude: short, gentle tap
3. Auscultation
1. Identify Anatomical Areas where you will listen 4 traditioal valve areas
Aortic valve area (2nd right interspace)
Pulmonic valve area (2nd left interspace)
Tricuspid valve area (5th intercostal space at left lower sternal border)
Mitral valve area (5th interspace at approx. left mid-clavicular line)
2. Rate & Rhythm
60-100 beats per minute
Regular (sinus arrhythmia is normal & increases at the peak of inspiration & slowing with expiration)
3. Identify S1 & S2 & Note any Variations
S1: start of systole & louder at apex (coincides with carotid artery pulse)
o Caused by closure of the AV valves
S2: start of diastole & louder at base
o Caused by closure of the semilunar valves
4. Listen in Systole & Diastole
Extra Heart Sounds
o Split S1: heard in tricuspid valve area
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Document Summary

Inspect & palpate carotid arteries: grade: right & left. 0 = absent, 1+ weak, 2+ normal, 3+ increased, 4+ bounding. Palpate each carotid artery medial to the sternomastoid muscle in the neck (symmetrical: avoid excessive pressure on the carotid sinus area higher in the neck. Feel contour (smooth with a rapid upstroke & slower downstroke) & amplitude (strength is 2+/moderate) Thrill = palpable vibration (signifies turbulent blood flow & accompanies loud murmurs: heave or lift. Sustained forceful thrusting of the ventricle during systole (eg. increased workload: apical impulse (point of maximal impulse) in the 4th/5th interspace at the mid-clavicular line. Size: 1x2 cm & amplitude: short, gentle tap: auscultation. Identify anatomical areas where you will listen (cid:894)4 traditio(cid:374)al valve (cid:862)areas(cid:863)(cid:895: aortic valve area (2nd right interspace, mitral valve area (5th interspace at approx. left mid-clavicular line) Tricuspid valve area (5th intercostal space at left lower sternal border: rate & rhythm.

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